@article{1614,
  keywords = {continuing education, continuing professional development, emergency department, patient safety, simulation},
  author = {Jeremy B. Branzetti and Adeyinka A. Adedipe and Matthew J. Gittinger and Elizabeth D. Rosenman and Sarah Brolliar and Anne K. Chipman and James A. Grand and Rosemarie Fernandez},
  title = {Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.},
  abstract = {<p><b>BACKGROUND: </b>A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay.</p><p><b>OBJECTIVE: </b>To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event.</p><p><b>METHODS: </b>This was a prospective, randomised controlled study to determine the effect of a JIT intervention on performance of TVP placement. Subjects included board-certified emergency medicine physicians from two hospitals. The JIT intervention consisted of a portable, bedside computer-based procedural adjunct. The primary outcome was performance during a simulated patient encounter requiring TVP placement, as assessed by trained raters using a technical skills checklist. Secondary outcomes included global performance ratings, time to TVP placement, number of critical omissions and System Usability Scale scores (intervention only).</p><p><b>RESULTS: </b>Groups were similar at baseline across all outcomes. Compared with the control group, the intervention group demonstrated statistically significant improvement in the technical checklist score (11.45 vs 23.44, p<0.001, Cohen's  effect size 4.64), the global rating scale (2.27 vs 4.54, p<0.001, Cohen's  effect size 3.76), and a statistically significant reduction in critical omissions (2.23 vs 0.68, p<0.001, Cohen's  effect size -1.86). The difference in time to procedural completion was not statistically significant between conditions (11.15 min vs 12.80 min, p=0.12, Cohen's  effect size 0.65). System Usability Scale scores demonstrated excellent usability.</p><p><b>CONCLUSION: </b>A JIT intervention improved procedure perfromance, suggesting a role for JIT interventions in rarely performed procedures.</p>},
  year = {2017},
  journal = {BMJ Qual Saf},
  volume = {26},
  pages = {881-891},
  month = {11/2017},
  issn = {2044-5423},
  doi = {10.1136/bmjqs-2017-006656},
  language = {eng},
}